Pygeum

DÓNAL O’MATHÚNA looks at the use of pygeum in treating benign prostatic hyperplasia.

PYGEUM is a herbal remedy made from the bark of a tree that grows in the mountainous regions of Africa. Variously called the African plum tree or prune tree, it has been used in traditional African medicine for bladder problems and “old man’s disease”.

Knowledge of such uses reached Europe in the 1960s and pygeum quickly gained a reputation for the treatment of benign prostatic hyperplasia (BPH). Pygeum is the most popular treatment for BPH in some European countries. However, the increased demand for the herbal remedy led to such widespread harvesting that the tree was placed on the list of endangered species in 1995. Efforts are now under way to cultivate the tree for medicinal usage, especially in Kenya.

BPH is a common condition affecting older men. It is estimated that about 20 per cent of men in their 40s are affected by BPH, increasing steadily to 90 per cent of men in their 70s. BPH results from enlargement of the prostate gland, though it is not a type of cancer. After urine collects in the bladder, it is passed via a tube, the urethra, which goes through the prostate gland. Hence, the symptoms of BPH include a variety of problems with urination, especially an inability to empty the bladder completely.

The precise nature and severity of the symptoms can vary widely because the prostate, bladder and urethra are affected differently in individuals. A number of pharmaceutical and surgical procedures are available, but they all have limitations and side effects. Hence, much interest has developed in herbal remedies for BPH.

Evidence from studies

Extracts of pygeum bark contain a number of compounds called phytosterols. One of these plant steroids, beta-sitosterol, has some properties similar to finasteride, a pharmaceutical used to treat BPH. Laboratory studies have shown that pygeum extracts can slow the type of tissue growth that occurs when the prostate enlarges. Also, pygeum contains compounds which protect animal bladders from the type of damage that results when their urinary tracts become blocked for various reasons.

Several dozen clinical trials have been conducted on pygeum, although many have been “open label”. In these, researchers and patients know what treatment each person receives which leads to a higher risk of bias than when studies are “double blinded”.

A more recent review of only double-blind studies found encouraging results. On average, various symptoms were improved by 20-25 per cent in men taking pygeum compared with those taking a placebo. However, the results of these trials are limited by their quality. This is particularly problematic with BPH as placebos lead to improvements in 30-40 per cent of men with BPH symptoms. Also, studies have lasted no more than a few months, while BPH is a chronic condition requiring treatment for decades.

Long-term studies are needed, such as the CAMUS trial, currently being funded by the US National Institutes of Health. It has already enrolled 3,000 men to compare the effectiveness and safety of pygeum, saw palmetto, a pharmaceutical drug and a placebo. Results will not be available until 2012.

Problematic aspects

Pygeum is well tolerated, although gastrointestinal problems can affect some people. Men with BPH should be carefully monitored for the development of more serious conditions. Although BPH does not lead to prostate cancer, men with prostate cancer often have BPH also. There is no evidence that pygeum or any other herbal remedy prevents or treats pancreatic cancer. Herbal remedies should not be used in place of medical evaluations.

Recommendations

Studies have shown that many men with mild BPH symptoms prefer “watchful waiting” to any treatment. Combined with an annual medical check-up, such an approach did not lead to any further problems compared with those who started medical treatment earlier.

The evidence from controlled trials suggests that pygeum extracts may provide moderate relieve for some men. Trying pygeum for a couple of months while monitoring one’s symptoms may be beneficial when the symptoms become more bothersome. Usually 100-200mg of a standardised extract is taken daily.

A medical evaluation should be conducted first to ensure a proper diagnosis and to rule out more serious conditions.